Nephrotoxicity chronic

Sirolimus is used for tissue transplantation where its major advantage over calci-neurin inhibitors is that it is not nephrotoxic. Chronic renal failure in transplant patients who have taken calcineurin inhibitors for the long term can be prevented by the administration of sirolimus. Steroid-free immunosuppression can be achieved by administering sirolimus alone or in combination with mycophenolate mofetil and cyclosporine or tacrolimus. Since impaired wound healing is one of its potential side effects, some transplant centers use sirolimus only after several weeks of surgery. 

Effects of repeated ethylene glycol peroral overexposure in treated rats and mice can result in kidney, Hver, and nervous system damage. The most sensitive indicators of ethylene glycol toxicity are disturbances in acid—base balance and nephrotoxic (kidney) effects. Effects of repeated chronic peroral overexposure of diethylene glycol in treated rats result in kidney and Hver damage (48). 

One of the major drawbacks of calcineurin inhibitors is their ability to cause acute and chronic nephrotoxicity. Acute nephrotoxicity has been correlated with high calcineurin inhibitor doses and usually is reversible. Chronic toxicity, however, typically is irreversible and is linked to chronic drug exposure. Table 52—4 expands on the more common calcineurin inhibitor-induced adverse events. 

Methotrexate has been used successfully with cyclosporine, either concurrently34 or in rotation. Rotational therapy is particularly effective since it minimizes the serious adverse effects of both agents hepatotoxidty from methotrexate and hypertension and nephrotoxicity from cyclosporine. Having an overlapping treatment period may not be necessary and patients have been successfully switched after a 1-week washout period.21,35 This is a very useful combination of systemic agents in the longterm management of this chronic disease. 

Chronic exposure to Pb has been shown to cause anaemia, neurotoxic effects, such as reduced cognitive performance and reduced peripheral nerve conduction velocity, and nephrotoxicity. Children are more sensitive to exposure to Pb than adults, especially during the first 2 years of life [41], For children, exposure to lead can cause growth retardation, affect the neuropsychological development and cause encephalopathy [39]. Adverse reproductive effects due to lead exposure have been observed for both men and women. Exposure of pregnant women to low concentrations of lead is associated with miscarriages and low birth weights [40],... 

Toxicity It is carcinogenic, hepatotoxic, nephrotoxic, and mutagenic to mammals Chronic toxicity may be predominant for DEHP no obvious acute toxicity Bioconcentration factor (BCF) is high, and the persistence is medium... 

Ochratoxin A (OTA) is a my cotoxin produced by some species of Penicillium and Aspergillus. It is nephrotoxic to all animal species tested and the causal agent of mycotoxic porcine nephropathy (Krogh, 1978). It was previously associated with the human renal disorder, Balcan endemic nephropathy (BEN), and tumours of the urinary tract (Pfohl-Leszkowicz et al., 2002). Recently, another endemic kidney disease (Tunisian chronic interstitial nephropathy, CIN) was linked to OTA-contaminated food (Creppy, 1999 Wafa et al.,... 

Antibiotics with activity against urease-producing bacteria, such as neomycin [42], paromomycin [44] or metronidazole [45], also reduce the production of intestinal ammonia and have proved to be of value. Vancomycin has also been used in patients with lactulose-resistant chronic encephalopathy [46]. The efficacy of neomycin is similar to that of lactulose [42]. However, a small percentage of this drug is absorbed from the gastrointestinal tract and may cause ototoxic and nephrotoxic effects, especially with continuous use over several months [47]. This drug should be used with particular caution by patients with renal insufficiency. The efficacy of metronidazole for... 

NS-CA are classically regarded as being nephrotoxic in patients with preexisting chronic renal failure [34]. 

Toxicology. Cadmium oxide fume is a severe pulmonary irritant cadmium dust also is a pulmonary irritant, but it is less potent than cadmium fume because it has a larger particle size. Chronic exposure is associated with nephrotoxicity. Several inorganic cadmium compounds cause malignant tumors in animals. 

Nephropathy has been associated with chronic lead poisoning. " A study of two large cohorts of heavily exposed lead workers followed through 1980 demonstrated a nearly threefold excess of deaths attributed to chronic nephritis or other hypertensive disease, primarily kidney disease. Most of the excess deaths occurred before 1970, among men who began work before 1946, suggesting that current lower levels of exposure may reduce the risk. Experimental animal studies suggest there may be a threshold for lead nephrotoxicity, and in workers, nephropathy occurred only in those with blood levels over 62p,g/dl for up to 12 years."... 

Renai function impairment Use amphotericin B desoxycholate with care in patients with reduced renal function frequent monitoring is recommended (see Precautions). Lipid formulations have been reported to overcome most problems of chronic nephrotoxicity, even in patients with impaired renal function following previous treatment with amphotericin B desoxycholate. 

In patients at risk of or having renal dysfunction, chronic administration of adefovir may result in nephrotoxicity. Closely monitor for renal function and adjust dose as required. 

Cefditoren (Spectrac ) [Antibiotic/Cephalosporin-3rd Generation] Uses Acute exacCTbations of chronic bronchitis, pharyngitis, tonsillitis skin Infxns Action 3rd-gen cqjhalosporin -I- ceU wall S5mth Dose Adults Feds >12 y Skin 200 mg PO bid X 10 d Chronic bronchitis, pharyngitis, tonsillitis 400 mg PO bid X 10 d avoid antacids w/in 2 h take w/ meals X in renal impair Caution [B, ] Renal/hqiatic impair Contra C halosporin/PCN allergy, milk protein, or carnitine deficiency Disp Tabs SE HA, N/V/D, cohtis, nephrotox. 

Ogawa M, Mori T, Mori Y, et al. 1992. Study on chronic renal injuries induced by carbon tetrachloride selective inhibition of the nephrotoxicity by irradation. Nephron 60 68-73. 

Vyskocil A, Viau C, Cizkova M. 1994b. Chronic nephrotoxicity of soluble nickel in rats. Hum Exp Toxicol 13 689-693. 

Compared with previously available therapy, the adverse effects associated with cyclosporine are much less severe but still worthy of concern. Nephrotoxicity, which can occur in up to 75% of patients, ranges from severe tubular necrosis to chronic interstitial nephropathy. This effect is generally reversible with dosage reduction. Vasoconstriction appears to be an important aspect of cyclosporine-induced nephrotoxicity. Hypertension occurs in 25% of the patients and more frequently in patients with some degree of renal dysfunction the concomitant use of antihypertensive drugs may prove useful. Hyperglycemia, hyperlipidemia, transient liver dysfunction, and unwanted hair growth are also observed. 

Campistol JM and Grinyo JM. Exploring treatment options in renal transplantation The problems of chronic allograft dysfunction and drug-related nephrotoxicity. Transplantation 2001 71 SS42-SS51. 

Nephrotoxicity associated with chronic therapy. Monitor renal function during therapy. 

The kidney has a marked ability to compensate for tissue damage and loss, and consequently, unless it is evaluated immediately, nephrotoxic effects may not be recognized. Similarly, chronic toxicity may not be detected because of this compensatory ability. 

Uses Herpes simplex zoster Tnfxns Action Interferes w/ viral DNA synth Dose Adults. Dose on IBW if obese >125% IBW PO Initial genital herpes 200 mg PO q4h while awake, 5 caps/d x 10 d or 400 mg PO dd x 7-10 d Chronic suppression 400 mg PO bid Intermittent Rx As inidal Rx, except Rx for 5 d, or 800 mg PO bid, at prodrome Herpes zoster 800 mg PO 5x/d for 7—10 d IV 5—lOmg/kg/dose IV q8h Topical Initial herpes genitalis Apply q3h (6x/d) for 7 d Peds. 5-10 mg/kg/dose IV or PO q8h or 750 mg/m2/24 h + q8h Chickenpox 20 mg/kg/dose PO qid w/ CrCl <50 mL/min Caution [B, +] Contra Hypersensitivity to compound Disp Caps, tabs, susp, inj, oint SE Dizziness, lethargy, confusion, rash, inflammation at IV site Interactions T CNS SE W/ MTX zidovudine, T blood levels H7 probenecid EMS Can cause Szs OD Causes nephrotox which can progress to ARF use fluids w/ caution, symptomatic and supportive... 

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